>> over the coming decades, the number of people 85 and over in the us is expected to more than triple... the hope is they'll get good care, and lead an active, secure and engaged life. >> o sixty nine... >> n thirty one... >> the odds are that nearly half of the people in this room will spend some time in a nursing home. and as the business of elderly care grows, making the right choice has never been harder. >> they're putting profits ahead of people and they're increasing those profits on the backs

of the nursing home residents who are being exploited, neglected, and abused. it is epidemic. >> this week fault lines investigates the business of elderly care. >> this facility in oklahoma city provides the type of care most people would hope for in their golden years. it has very high standards, and above average staffing levels. but for the majority in the us who rely on government reimbursements for elderly care, like medicaid, the reality can be quite different. >> he pulled the light and nobody would come for an hour.

so pretty early we were suspicious of the place. my dad would call frantic, every single morning, because feces and urine were running off the bed. >> continuing down the hallway, i see no staff helping people. i hear people crying out for help. nobody responding to them. >> abuses are hidden, sometimes coming to light only when suspicious family members plant hidden cameras. >> we just couldn't believe it. you didn't even want to look at it again, it was so terrible. >> what was going through your mind. >> just thinking about all the other times she may have been abused and we just happened to get that one on camera. >> fault lines had been

contacted by a lawyer in south carolina who says he's bringing a case against a corporation that manages care homes. it happened in augusta, georgia. the victims name is pat manning. we're meeting with his wife today, nora manning. we want to investigate what happened. nora manning is claiming that the facility where her husband was sent for care, amara health care and rehab, badly neglected her husband. >> this is pat, there's mr. manning... >> pat manning suffered a stroke in 2011, at the age of 60, that limited his mobility. according to his wife, he walked into amara nursing home for care and rehabilitation that was predicted to last only 6 weeks. >> he's my sweetie. see how good pat looked there? so handsome. but nora says that pat wasn't getting the care he needed.

she alleges he was so neglected, he developed bed sores. that he was denied physical therapy, and lost all mobility; he was dehydrated and malnourished. >> he smelled, his hair was dirty, his butt was dirty. told by doctors he was dying, she took him home. he passed away a few weeks later of sepsis due to infection. > pat died for no reason, mi hijo. people have got to know what these nursing homes consist of. they don't care, they're there for a paycheck. >> nora's lawyer shot video footage of pat's condition before he died - she hasn't been able to bring herself to watch it. >> and you've never watched this video? >> i've never watched the video. >> do you want to watch the video? >> no, i'm scared to see it. i can't.

>> this video is critical evidence in nora's case. the images are disturbing. >> nora is trying to take care of pat. he's covered in sores. the sores on his foot are so bad that the bone is sticking out. >> he said he's in pain, give him something else. the man in this video is completely unrecognizable from the photos we saw at nora's house. >> [crying] i'm sorry. i'm sorry.

the medicare review board gave amara only one star - defined as "much below average" in an overall rating. but despite that low rating, there have been no fines or penalties levied in at least the past three years. and across the us, there's little consistency to how facilities get fined for giving bad care. >> people ask me all the time. why doesn't the state close down bad nursing homes. well, if that was the case, okay? then there really wouldn't be any nursing homes open. it's like a yo-yo effect in nursing homes. >> brian lee used to be an independent watchdog for state and federal regulation of nursing homes. now he's a whistle blower. >> i saw stuff that blew my mind. i've been in nursing homes where

the door opens up and i'm blasted by the smell of urine and feces. i've seen residents wheeled to showers completely nude in the hallway, exposed. bed sheets off of them, people walking around naked no dignity whatsoever. i've seen warehousing of elderly people in nursing homes. this reimbursement based system that they're in, almost 80% of their funding comes from reimbursements by tax payers. so they get paid regardless of the quality of care. whether it's good care or it's bad care.

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fault lines is investigating whether nursing homes answer for the quality of thier care. we've come to amara nursing home in augusta, georgia to ask some questions. >> we've called to request some interviews and they all get turned down, so we've decided we're going to knock on their door and see if we can find out what happened with pat manning. >> who's in charge right now? is there a manager here? >> where are you all from? we're from a show called fault lines. >> hey guys. >> hey. >> i've been instructed to ask you guys to leave. >> we want to speak to mr. williams first. >> he asked if you guys could please leave. >> do you remember pat manning as a patient? >> i can't answer any questions. >> i can't talk to you; he's been instructed to not answer any questions and i've just been asked to ask you guys if you can leave. >> ok, let me ask you this, this says premiere performance oriented. you're a one out of five stars on the state inspection. what's happening at this nursing home?

>> i'm sorry, i've been instructed to not answer any questions. sorry you guys have a good day. >> in your mind was it the stroke, the after effects of the stroke that killed mr manning. >> no, nope. >> what killed him? >> the nursing home. >> so, just to be clear, you feel that their neglect.. >> bad neglect, sir. >> led directly to his death. >> yes. with all of my heart and soul, my grandchildrens - the love of my husband, yes. >> nora will have a hard time proving her belief in court. if there's some level of care, abuse and neglect are difficult to prove beyond a reasonable doubt. we went to georgia's emory university, one of the best medical schools in the country, to meet an expert on elder abuse, dr. tom price

>> what are some of the signs of someone who's suffered neglect? >> one of the signs you could see would be dehydration, you could see malnutrition, pressure ulcers is one that people tend to focus on is potentially a sign of neglect. >> dr price says that many of the symptoms of abuse could also be symptoms of the underlying disease that brought the person to the nursing home in the first place. but that abuse is more common than previously thought. >> how many people suffer abuse in nursing homes but they have no family, they have no one to speak for them, so when they die, they die. so most of these things that are occurring, when a death occurs from neglect it's just basically not being detected, and part of that is that there is no surveillance apparatus, and when there is, like we have a regulatory body in georgia that does that, i've seen every law enforcement official i've worked with exhausted from the sheer number. >> we have a veritable epidemic of abuse and neglect in nursing homes around this country. i've tried cases literally from

florida to california and i can tell you that this is a pervasive problem across the country and it's one that's growing. >> ken connor's law firm says it plans to represent nora manning in a lawsuit for what they say is the wrongful death of her husband. victims in some other states often don't have access that kind of legal recourse. after intense lobbying, several states have capped the limit victims and their families can sue for in court. >> well, you have to understand the way washington really works. and if you want to understand that you need to follow the money. >> the nursing home industry is so darn powerful that they put a lot of pressure upon public officials they through campaign contributions... and money is the megaphone. the lobbyists have the ear of the legislators. >> ombudsman don't have that. residents don't have that. >> lobbyists and lawmakers behind closed doors, decide what the industry can live with and cap out the recoveries at that level.

and then impose that on the public. and the problem is, when you immunize wrong-doers from the consequences of their neglect, they're more likely to repeat that neglect. and they're neglect multiplies. >> that lack of corporate accountability has left the mayberry sisters angry. their ninety six-year-old mother erytha suffered dementia. so they put her in what they thought was a good nursing home - in oklahoma city. >> when the daughters began to notice some of erytha's personal items missing, they came up with a plan to do something about it. >> we said well why don't we put a camera in the room, because then we could catch the theft. so we put the camera in the room and never expected, never saw

any thievery, saw the abuse. >> they saw a nurse's aid forcing a latex glove into their mother's mouth. while police took action, the state health agency did nothing. in their frustration to make the case public, the mayberrys turned to wes bledsoe. he's been fighting at the state level to make elderly care homes accountable for the last 13 years, after he says he lost his own grandmother to gross neglect. >> the family gave me the video to release to the media, and people are just outraged and stunned by it. >> "the horrible torture of an elderly woman caught on tape. one of the women... >> if it had not been for the hidden camera, no on would ever know. mrs. mayberry was the perfect silent victim. >> the state health department initially claimed an investigation was unnecessary because the facility took prompt

action. one of the nurse's aides went to jail. >> i then met with the state commissioner of health and asked him about this, and he goes "well the police investigated. what more do you want?" that's like saying the plane crashed and the cops showed up and they did what they were supposed to do, and that's it. and the national transportation safety board didn't have to do anything because the cops were there. the regulatory agency is there to enforce regulations. >> at the time of filming, the home had not been fined for the abuse erytha mayberry suffered. >> are you surprised that the state agencies haven't been more supportive? >> definitely. oh yes. >> they don't want it investigated. they don't want people to know how bad the nursing homes in the state of oklahoma are. >> and if you're not watching them, if there's no oversight, they can basically just run wild. and that's exactly what's

happening. >> but, i mean what are you looking at? a couple of bad apples? a couple bad nurses? bledsoe: uh, no. this is an industry wide trend. you have minimally trained staff, that's under staffed, under equipped, to deal with all the different needs that this population has. >> it's easy to blame individual staff members as perpetrators of abuse. but how do management decisions affect staff quality? >> it's low pay. you have probably better benefits, better pay, working in a fast-food restaurant, then in a nursing home. staffing is the lynchpin to good care. but the owners are telling the administrators keep the staffing low because we want to keep those profits high. they're making record medicare revenues, record profits. anytime a nursing home comes up

for sale, it's a feeding frenzy, it's a bull market. why is it so good? because it's guaranteed money. >> for brian lee - his role as florida's ombudsman for long term care meant that he went up against nursing home corporations in the state. >> if you're making multi- multi- billion dollars and somebody's going to come in and disrupt it somehow, by tracking down how you're getting paid, they are afraid of that. >> he says he was forced to resign in 2011, after flagging problems with the corporate structures and reimbursement systems. >> as state ombudsman i had this provision, the affordable care act to ask for the nursing homes for this corporate information for more transparency. i made the request, within days the nursing home industry contacted the governor, within days of that, okay, i was fired. what happens when social media

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>> many nursing homes are controlled by engage with management corporations that make some of the decisions at facilities. we've come to one of them -

altacare corportation. >> we are conducting a stake out, which basically means sitting outside someone's office, hoping they're coming to work today, hoping we get here before they get here so that maybe we get to ask them some questions on their way in. altacare corporation is a management group that has operated in nursing homes across the us, including amara - the nursing home where pat manning was allegedly neglected. the company is also involved in a federal lawsuit for allegations of fraud in a home in mississippi. the owner doug mittleider refused requests from fault lines for an interview. the only way to speak to him was to catch him as on his way to the office. the widow of one of the patients there says that her husband died of neglect, can we sit down with you and have an interview with you about it? >> sometime, sure.

>> sometime, yeah? can we set the date and time now? >> no. >> can you answer questions about it now? >> no. >> do you have response to the allegations to the lawsuit that the federal government's joined? that says that you rationed care? including oxygen bottles? >> i don't know what you're talking about. >> you don't know that there's a lawsuit by the federal government about one of your homes in mississippi? [silence.] >> mittleider had no comment. none of the industry representatives that we contacted for an interview would speak to us either. >> there's a corporate shell game that goes on, that conceals who really is running the nursing home. they'll set up a company or llc that owns the property, they'll set up another that holds the license, they'll set up another that manages the company, and the goal is to fragment the corporate structure in such a way that the lawyer can't figure out who is really responsible

for the wrong-doing. >> while corporations like altacare may continue to operate in some nursing homes, a growing trend is billion-dollar private equity firms operating hundreds of facilities across the country. >> it means that threads of responsibility are even harder to unravel for lawyers like connor. one such private equity firm operates hundreds of facilities nationwide under the name golden living. >> this is one of the largest nursing home companies in the us, it's interesting actually last year the fbi actually investigated golden living and came out with a report earlier this year that said they were fraudulently charging the us government for not only poor care but care that was actually harmful to their own patients. the company paid a fine of more than $600,000 to settle the case involving two atlanta facilities, and signed a corporate integrity agreement to

improve care, but it didn't have to admit liability. >> the way the corporate model is set up, it's so convoluted, so complex, the nursing home owners are so protective of accountability, multiple layers upon layers of companies that protect the corporate decision makers. >> madeline leftridge lived at a golden living center in southaven, mississippi. she died at age 72 from complications due to alzheimer's, according to her daughters carmen belton and lisa perkins. they believe their mother unduly suffered at the center. hospital records show that she was dehydrated, and that she'd developed a severe ulcer. >> her back was open. and it was [cried] ... it was probably three inches

deep in her bottom. >> and they kept telling us, she doesn't feel it. yeah. and i'm like do you see the size of this sore, and you're telling me she's not in pain? >> so i made sure that once my mom went back to the nursing home, that they were aware of it and to start treating it, like they were in the hospital. you have to keep turning her but you have to make sure that the area stayed dried and clean. we found out that that wasn't happening. >> in response, golden living said it emphasizes quality care and holds industry records in the number of top rated facilities across the us. >>they never said neglect, it was more, well, because she has diabetes it's going to be more difficult for her body to heal. and which, i can understand that, however, why did it even get to that point? that's the part that i never got an answer.

>> like in the manning case, it's hard to determine whether ulcers and other end-of-life symptoms were preventable, or not. but what is known is that in just one year, an estimated $5.1 billion of taxpayer money went to poor nursing home care, according to the government's own reporting. the office of health and human services in atlanta, georgia, is leading the way in bringing more cases to court, spearheaded by special agent derrick jackson. >> so our purpose is to go in there and find out who's at fault. not only are we going to lock you up, we're also going to get the money back and repay the taxpayer for the money that they paid. >> the affordable care act passed by congress in 2010, made it easier for jackson to detect and go after systematic abuse in nursing homes. he equates it to fraud.

in a landmark case, atlanta nursing home operator george houser was criminally charged and convicted for submitting claims for care deemed so bad, it was worthless. >> it created case law to where we can start looking at these cases criminally because now we have a roadmap of success. it certainly should put any corporation on edge. if i was a corporation in this line of work, that's something i would be looking at to say now i can be held liable for some of the care that i'm giving. >> but jackson says that budget cuts in government spending mean that there isn't enough manpower to investigate the number of other possible abuses in the system. >> i wish we had a hundred more agents that we could proactively go into every nursing home around the country, and dive into their medical records and look into their billings, but we don't have the resources, we don't have the ability to do that.

>> america is dealing with its growing elderly population with a corporate response. it's meant that people are increasingly becoming a commodity. but when that happens, what it means to be human, and valued can be lost along the way. >> we are losing much of americas generation because of abuse and neglect, and its scandalous. >> if we don't have loved one in a nursing home today, we will have a loved one in a nursing home at some point in the future. >> thomas jefferson said, "the chief purpose of government is to protect life." we're not doing a very good job of protecting the lives and dignity of people in nursing homes in this country today.

>> this is al jazeera america, i'm tony harris. evidence that yasser arafat was poisoned. also coming up, john kerry's mission to israel and the west bank. and we'll look at the vicious drawing war in mexico. >> for nearly nine years there has been suspicions of foul play in yasser arafat's death, that mystery has been partially